EM/CC job market and lifestyle?

[neoevolution]

I was looking at older threads, but a lot seem to predate the BC pathway for CCM for EM docs. I had a few questions about it that I couldn't find recent answers for:

Is it easier now to find jobs allowing for a mix of EM and CC, and does academic v. community make a difference?
What are the relative hourly rates for EM vs. CC in the same geographical area?
Are jobs 7 on/7 off CCM with EM on the off week, or is it individual shifts of each without a weekly pattern?

---

Members don't see this ad.

 

[IH8ColdWeath3r]

I was looking at older threads, but a lot seem to predate the BC pathway for CCM for EM docs. I had a few questions about it that I couldn't find recent answers for:

Is it easier now to find jobs allowing for a mix of EM and CC, and does academic v. community make a difference?
What are the relative hourly rates for EM vs. CC in the same geographical area?
Are jobs 7 on/7 off CCM with EM on the off week, or is it individual shifts of each without a weekly pattern?

I am also interested in CC. I spoke with a number of intensivists and EM docs this year regarding this issue and the overwhelming majority of them told me that in order to practice CC as an intensivists, the best route is through IM followed by either a pulm/CC or CC fellowship as there is a lot of politics around EM guys practicing CC. Basically, a large number of hospitals require that you are board certified in IM if you want to work in the unit or CVICU. Again, the sample size was small but this was the overall consensus based on the people that I spoke too but I'm sure there are other on this forum who are far more informed than I am and can correct me if I am wrong.

 

[neoevolution]

I am also interested in CC. I spoke with a number of intensivists and EM docs this year regarding this issue and the overwhelming majority of them told me that in order to practice CC as an intensivists, the best route is through IM followed by either a pulm/CC or CC fellowship as there is a lot of politics around EM guys practicing CC. Basically, a large number of hospitals require that you are board certified in IM if you want to work in the unit or CVICU. Again, the sample size was small but this was the overall consensus based on the people that I spoke too but I'm sure there are other on this forum who are far more informed than I am and can correct me if I am wrong.

I would understand wanting to hire only pulm/cc docs, but that's weird that IM/CC is preferred over EM/CC even with the same fellowships and boards.

 

[Fox800]

I am also interested in CC. I spoke with a number of intensivists and EM docs this year regarding this issue and the overwhelming majority of them told me that in order to practice CC as an intensivists, the best route is through IM followed by either a pulm/CC or CC fellowship as there is a lot of politics around EM guys practicing CC. Basically, a large number of hospitals require that you are board certified in IM if you want to work in the unit or CVICU. Again, the sample size was small but this was the overall consensus based on the people that I spoke too but I'm sure there are other on this forum who are far more informed than I am and can correct me if I am wrong.

I have heard the exact opposite. Jobs abound and recruiters calling all the time. There is a definite shortage of intensivists, look at the movement towards eICUs. Two EM/CC docs at my program have told me there are tons of job opportunities out there.

 

[RustedFox]

Total guess on my part, but I can see the IM higher-ups thinking: "We need more CC staff. We don't need more CC staff that are gonna flake out and go do EM somewhere else down the road, perhaps real soon. We need dedicated CC staff."

 

[TheComebacKid]

As a resident strongly looking into the EM/CCM pathway, I can tell you that it's somewhat complicated and based on a variety of factors.

Overall, there is a general shortage of intensivists and most places are hiring aggressively. I would say by and large EM has a seat at the table, but it's true, the specialty has been largely dominated by the pulm/crit folks for awhile now.

The first question to ask: what kind of setting do you want to work in? Are you looking to work in the surgical ICU setting (i.e. SICU, CTICU etc)? Then the anesthesia-CCM pathway which is very welcoming of EM folks is a good pathway.

If you want to work be a medical intensivist in the MICU, then the you would likely have to go through the ABIM track. The pulm/crit people have had a monopoly on this for decades. I think being pulm/crit fellowship trained is just historically the most common pathway, and employers are just used to this. You can see pulm patients in clinic and increase revenue for your group.

The biggest problem that EM people face is not that employers are worried that you are gonna bail and go work in the ED, it's that it can be a little complicated to set up your practice where you do partial EM and partial CCM. In essence you have to get two departments who don't communicate with each other to support your salary. Because most EM groups don't staff ICUs one group may have to "buy your time" from the other, and this is a fairly new model.

That being said, it's changing. At my residency, we have 8 or 9 EM/CCM board certified docs. They are doing great from job satisfaction and opportunities (haven't asked them what their compensation is like). Most EM/CCM fellows at my institution have had their phones ringing nonstop from potential employers.

Check out the EMRA fellowship guide and read the section on Critical Care. Some useful information there.

 

[Hamhock]

Plenty of CCM-only jobs for EM-CCM.
This is especially true for ABIM-based fellowship trained docs; who can work as attendings in academic MICUs.

HH

 

[KinesiologyNerd]

Plenty of CCM-only jobs for EM-CCM.
This is especially true for ABIM-based fellowship trained docs; who can work as attendings in academic MICUs.

HH

That's good to hear. A little tougher though with the 5 months of IM requirement. My program does 3 and there are other electives I would consider outside of the MICU.

Good thing I have a long time to decide.

 

[deleted547339]

That's good to hear. A little tougher though with the 5 months of IM requirement. My program does 3 and there are other electives I would consider outside of the MICU.

Good thing I have a long time to decide.

Unless it's changed in the last year, it's 6 months, 3 of which must be MICU/CCU.

 

[KinesiologyNerd]

Unless it's changed in the last year, it's 6 months, 3 of which must be MICU/CCU.

I couldn't remember. So even accounting for elective time it's ¯\_(ツ)_/¯ for me.

 

[CCM-MD]

Market for intensivists is great and you shouldn't have a problem getting a pure CCM job. It might be a bit challenging to find a gig that lets you do both EM and CCM but you should still be able to find one. Unfortunately there is bias towards IM trained.

 

[PS2020]

I often hear how doing EM and CC is very stressful. That is why the pulm/CC gig works so well, 3 stressful days staffing the ICU, and 2 days doing pulm somewhere else to destress from the acuity. What makes EM/CC so attractive then?

Also, I tried searching for the hourly rates for this combination but couldnt find anything solid. Can someone give a $$ approximation and comment on the lifestyle aspect? Isnt it easier to make more money doing either EM or CC fulltime? Do more EM/CC guys gravitate toward academia? Bonus question, why is the CC market so good now; as in, why is there a shortage of crit care docs all of a sudden despite the rise in fellowship paths to critical care (anesthesia, em, im)? Thanks.

 

[CCM-MD]

I often hear how doing EM and CC is very stressful. That is why the pulm/CC gig works so well, 3 stressful days staffing the ICU, and 2 days doing pulm somewhere else to destress from the acuity. What makes EM/CC so attractive then?

Also, I tried searching for the hourly rates for this combination but couldnt find anything solid. Can someone give a $$ approximation and comment on the lifestyle aspect? Isnt it easier to make more money doing either EM or CC fulltime? Do more EM/CC guys gravitate toward academia? Bonus question, why is the CC market so good now; as in, why is there a shortage of crit care docs all of a sudden despite the rise in fellowship paths to critical care (anesthesia, em, im)? Thanks.

I have yet to see a pulm/CC gig thats 3 days ICU and 2 days pulm... generally isn't set up like that. Its usually 1 week/month in the ICU and the rest of the time doing outpatient pulm. The round in the ICU in the morning and work in your pulm office in the afternoon model has gone out of favor. Intensivist positions are usually week on/off or scattered shifts averaging 14-15 shifts every month. Theres very few EM/CC guys around. I know of one EM/CC doc who does 1 week of ICU nights every month at one hospital and ~5 ER shifts at a different hospital. I know another that only does ICU work.

Shortage of intensivists isn't sudden, it has been around for several years now, maybe you are just coming to know about it now. IM, anesthesia, and surgery have always been paths to critical care. EM was added, yes, but makes up a very small chunk. Some more info about the shortage in this document from 2006: http://www.feinberg.northwestern.edu/sites/anesthesiology/docs/AMAReport2006.pdf

 

[Angry Birds]

EM/CC job market and lifestyle?

I can't speak to market, but I just wanted to say something about lifestyle. EM is an extremely stressful job, and I wouldn't recommend coupling it with something as stressful as CC. The CC/pulm guys I know tend to start liking pulm much more than CC, especially as they age. I would seriously reconsider EM/CC.

Clarification: I may be biased, but I've rotated in the ICU a lot as a resident. I certainly didn't find it anywhere near as stressful as EM (because in CC the patient volume is way lower, you can do your job in series as opposed to in parallel, and you have downtime)... BUT, just the gloom-and-doom of the ICU would put me in a bad mood, especially after being exhausted from working in the ER.

 

[takeurmeds02]

I can't speak to market, but I just wanted to say something about lifestyle. EM is an extremely stressful job, and I wouldn't recommend coupling it with something as stressful as CC. The CC/pulm guys I know tend to start liking pulm much more than CC, especially as they age. I would seriously reconsider EM/CC.

Clarification: I may be biased, but I've rotated in the ICU a lot as a resident. I certainly didn't find it anywhere near as stressful as EM (because in CC the patient volume is way lower, you can do your job in series as opposed to in parallel, and you have downtime)... BUT, just the gloom-and-doom of the ICU would put me in a bad mood, especially after being exhausted from working in the ER.

I'm so glad to hear these perspectives. I've been trying my damnedest to shadow in the ICU to no avail but I have over two years EM exposure as a scribe. I strongly considered EM/CC but would much rather do EM over CC if the combined route is just too much to hash out from a personal well-being standpoint and in terms of time-splitting/compensation.

 

[Hamhock]

The ICU is so much less stressful than the ED...and the hours are so much easier.

HH

 

[neoevolution]

This might be slightly off-topic, but what's the best way to get exposure to EM? I don't have any third year rotations in it, but there is a strong residency for it at my institution; should I ask to shadow them on the weekends during my easier rotations this year?

 

[alpinism]

This might be slightly off-topic, but what's the best way to get exposure to EM? I don't have any third year rotations in it, but there is a strong residency for it at my institution; should I ask to shadow them on the weekends during my easier rotations this year?

Shadowing is always a good way to get exposure at most programs.

At some programs the rotation director might even let you set up a mini rotation where you work a couple weekend shifts.

 

[Brahnold Bloodaxe]

I have heard the exact opposite. Jobs abound and recruiters calling all the time. There is a definite shortage of intensivists, look at the movement towards eICUs. Two EM/CC docs at my program have told me there are tons of job opportunities out there.

Do you foresee this movement as being detrimental to the job market/earning potential of the field in the long run?